This essay provides a brief overview of the rise of organ trade in Pakistan towards the end of the last century and the concerted, collective struggle—of physicians and medical associations aided by the media, journalists, members of civil society, and senior judiciary—in pressuring the government to bring about and implement a national law criminalizing such practices opposed by an influential pro-organ trade lobby. It argues that among the most effective measures to prevent re-emergence of organ trafficking in the country is (...) increasing ethical live donations and above all, establishing sustainable, public supported deceased donor programs. To do this, the transplant community must recognize that organ transplantation is not merely a donor-recipient-physician transaction but a complex issue in which decisions to donate an organ are influenced by indigenous values and belief systems about human illness, life and death. (shrink)

Despite the majority opinion of Muslim jurists that organ donation is permitted in Sharia, surveys indicate continuing resistance by lay Muslims, especially to donating organs following death. Pakistan, a country with 165 million Muslims, currently reliant on live donors, is considering steps to establish deceased donor programs which will require public acceptance and support. This article analyzes the results of in‐depth interviews with 105 members of the public focusing on opinions and knowledge about juristic rulings regarding kidney donations, (...) donor‐family dynamics in deceased donation decisions, and attitudes towards buying kidneys. The objective was to determine the influence if any of cultural and religious values, and norms of traditional family structures and kinships, on decisions to donate. Study participants view donation of kidneys, particularly from the deceased, through a different lens from that used by jurists and physicians, one that also does not conform to familiar paradigms defining ethical organ donation. A socially modulated understanding of Islam passed down the generations, and longstanding family‐centric norms, shape the moral worldview of many rather than academic juristic rulings or non‐contextual concepts of autonomy and rights. The results of this study also highlight that medical science may be universal but its application occurs within particularities of cultural and religious values, social constructs of the self and its relationship with others, and different ways in which humans comprehend illness, suffering, and death. These findings are of relevance both to transplant related professionals and bioethicists involved with this field. (shrink)

This study compares the neural substrate of moral decision making processes between Korean and American participants. By comparison with Americans, Korean participants showed increased activity in the right putamen associated with socio-intuitive processes and right superior frontal gyrus associated with cognitive control processes under a moral-personal condition, and in the right postcentral sulcus associated with mental calculation in familiar contexts under a moral-impersonal condition. On the other hand, American participants showed a significantly higher degree of activity in the bilateral anterior (...) cingulate cortex (ACC) associated with conflict resolution under the moral-personal condition, and in the right medial frontal gyrus (MFG) associated with simple cognitive branching in non-familiar contexts under the moral-impersonal condition when a more lenient threshold was applied, than Korean participants. These findings support the ideas of the interactions between the cultural background, education, and brain development, proposed in the field of cultural psychology and educational psychology. The study introduces educational implications relevant to moral psychologists and educators. (shrink)

This case study focuses on how divergent cultural norms can impact ethical decisionmaking between a superior and subordinate in a high-pressure workplace. In order to ensure that today’s business students adhere to the highest standards of ethical conduct in an international and multicultural environment, it is imperative they recognize and respond appropriately to different cultural views of ethics. In the accompanying case, Jane, a Chinese national living and working in the United States, encounters multiple ethical dilemmas during her (...) employment at TrustUS. Readers are introduced to important cultural factors that differ between Eastern and Western societies and are asked to apply these concepts to gain insight into how cultural background might influence the ethical decision making of a professional in a managerial accounting context. (shrink)

ABSTRACT This study examined how lifestyle factors and gender affect kidney allocation to transplant patients by 99 British and Singaporean participants. Thirty hypothetical patients were generated from a combination of six factors and randomly paired four times. Participants saw 60 patient pairings and, in each pair, chose which patient would receive treatment priority. A Bradley-Terry model was used to derive coefficients for each factor per participant. A mean factor score was then calculated across all participants for each factor. Participants (...) gave lower priority to patients who drank more, were overweight, smoked more and exercised less. A patient’s diet and gender had no significant effect on allocation. There were no significant cross-cultural differences. There were moderate correlations between participants’ self-reported pre- and post-experiment ordering of decision criteria, and these measures and factor coefficients, suggesting a modest level of decision-making consistency. Between participants, moderate levels of concordance with respect to factor importance were observed for self-reported orderings of factors, and weaker agreement for model-derived coefficients. Very similar results were obtained for both British and Singaporean participants, and the implications of the findings are discussed. (shrink)

With the rapid development of information and communication technology, social media-based donation platforms emerged.1 These platforms innovatively demonstrate peer information on the donation page, which inevitably brings the peer influence into donors’ donation decision process. However, how the peer influence will affect the psychological process of donation decisions are remained unknown. This study used the number of donated peers to examine the effects of peer influence on donors’ donation decisions and extracted event-related potential (...) from electroencephalographic data to explore the underlying psychological process. The behavioral results indicated that the number of donated peers positively influenced donors’ willingness to donate. The ERP results suggested that a larger number of donated peers might indicate a higher level of conformity and greater perceived emotional rewards, as a larger P2 amplitude was observed. Following the early processing of emotional stimuli, cognitive detection of decisional risk took place, and the donors reckoned a smaller number of donated peers as a high potential risk, which was reflected by a larger N2 amplitude. In the later stage, the larger number of donated peers, which represented a higher magnitude of prospective emotional rewards, led to a higher incentive to donate, and reflected in a larger amplitude of P3. Additionally, implications and future directions were discussed. (shrink)

Free and informed choice is an oft-acknowledged ethical basis for living kidney donation, including parental living kidney donation. The extent to which choice is present in parental living kidney donation has, however, been questioned. Since parents can be expected to have strong emotional bonds to their children, it has been asked whether these bonds make parents unable to say no to this donation. This article combines a narrative analysis of parents’ stories of living (...) kidney donation with a philosophical discussion of conditions for parental decision-making. Previous research has shown that parents often conclude that it is “natural” to donate. Our study shows that this naturalness needs to be understood as part of a story where parental living kidney donation is regarded as natural and as a matter of non-choice. Our study also highlights the presence of a parenthood moral imperative of always putting one’s child’s needs before one’s own. On the basis of these results, we discuss conditions for decision-making in the context of parental LKD. We argue that the presence of a parenthood moral imperative can matter with regard to the decision-making process when parents consider whether to volunteer as living kidney donors, but that it need not hamper choice. We emphasise the need for exploring relational and situational factors in order to understand parental decision-making in the context of parental LKD. (shrink)

Organ donation is a life-saving process for patients suffering from an advanced organ failure. A disparity between donated organs and required organs for transplantation is one of the major problems in Iran. Since personal attitudes about organ donation is a main factor influencing willingness to donate organ, the present study sought to provide a deeper understanding of the attitudes of university students in Iran regarding organ donation. This qualitative study was conducted in 2016. Semi-structured interviews were held (...) for collecting data from eighty five students from various universities in Hamadan city, Iran. Using a purposive sampling method, the students were selected based on the maximum variation. The content analysis method was used for data analysis by the research team and criteria for the study’s rigor was considered. Overall, the students had positive attitudes toward organ donation by brain-dead patients. Nevertheless, not of them stated that they would become an organ donor. During the data analysis, 376 primary codes, 13 categories, and 6 themes were developed. Themes were “cognitive readiness”, “mediators of decision making”, “beliefs and motivations”, “interactions with the health system”, “dependency”, and “integrity of the body”. Also, thirteen sub-themes were developed. Many factors influence the students’ attitudes toward organ donation. Identification and explanation of these factors can help healthcare managers and policymakers for planning and improving the organ donation culture in the society. (shrink)

Multinational corporations face a litany of challenges regarding ethical decision-making as they traverse new variables in each country they operate in. Presented here is a new approach to ethical decision-making research for multinational corporations with the inclusion of moral virtues, national culture, and a feedback mechanism. The new proposed model builds off of the existing work by Trevino’s Person-Situated Interactionist Model. Hofstede’s work on individual national culture characteristics is used to move the conversation forward by explaining the relationships between individual (...) moderators in Trevino’s model and the effect of national culture on them. The new proposed model recommends the inclusion of moral virtues, with honesty and integrity as examples, as individual moderators in the decision-making process based on previous work. It contributes to the literature by introducing moral virtues into traditional ethical decision-making process models and introduces a new variable with a feedback mechanism for future learning. The paper concludes with recommendations for the future direction of research for ethical decision-making models for multinational organizations. (shrink)

Norway’s living kidney donation-rate is among the highest in the world ( 36 per million ). According to questionnaire-results, donors enjoy better than average health, presumably due to the strict medical criteria for being allowed to donate and life long medical follow up. However, in recent years international studies have cast doubt on the predominantly positive picture of donors and recipients, particularly regarding psychological aspects of transplantation surgery and donor evalutation. Findings in this study derive from anthropological fieldwork (...) lasting 36 months at three university hospitals in the Oslo-basin. 18 end stage kidney disease patients and their potential donors were recruited opportunistically and interviewed (separately) in three or more semi-structured conversations during the evaluation process and after transplantation. 3 cases are discussed in detail. Notes were transcribed and analysed according to narrative theory. Focus was to explore the content of donors’ and recipients’ pre- and post-transplantation narratives and to examine whether these accounts warrant a need for more comprehensive psychological assessment than is current practice in Norway. Donor- and recipient-narratives are well suited as a tool to improve living kidney donation-decisions. The material indicates a need to offer psychological care to LKD-partners, before and after transplantation. (shrink)

Advances in artificial intelligence and computer graphics digital technologies have contributed to a relative increase in realism in virtual characters. Preserving virtual characters’ communicative realism, in particular, joined the ranks of the improvements in natural language technology, and animation algorithms. This paper focuses on culturally relevant paralinguistic cues in nonverbal communication. We model the effects of an English-speaking digital character with different accents on human interactants (i.e., users). Our cultural influence model proposes that paralinguistic realism, in the form of (...) accented speech, is effective in promoting culturally congruent cognition only when it is self-relevant to users. For example, a Chinese or Middle Eastern English accent may be perceived as foreign to individuals who do not share the same ethnic cultural background with members of those cultures. However, for individuals who are familiar and affiliate with those cultures (i.e., in-group members who are bicultural), accent not only serves as a motif of shared social identity, it also primes them to adopt culturally appropriate interpretive frames that influence their decision making. (shrink)

Kidney transplantation is a lifesaving medical treatment. However, very high demand for kidneys with low kidney donation causes a black market that exploits patients’ desperation and donors’ vulnerability. The current kidney donation programs fail to produce promising results to avoid illegal and unethical kidney trafficking and commercialism. Even though the primary goal of kidney donation is to increase the number of deceased organ donations, in some countries, like Turkey, due to religious or (...) cultural concerns, it is impossible to supply adequate deceased kidney donations. In this view, the aim of this paper is to examine kidney trafficking in the scope of Turkey's current organ donation system and propose a new model, named the Incentivized Kidney Donation Model (IKDM), to increase kidney donation from living donors. The model encompasses the following benefits offered to kidney donors; lifetime health insurance, exemptions from copayments/contribution shares, priority when receiving an organ, priority when finding a job, income tax exemptions for salaried employees, and free or discounted public utilities. This normative model has the potential to promote donors’ altruistic acts as well as the solidarity and loyalty among members of a society without violating ethical values and internationally accepted principles. (shrink)

Many studies have shown that women are more likely than men to be living kidney donors, and the discrepancy is particularly marked in heterosexual couples: wives are more likely than husbands to donate a kidney to their spouse. This ‘ Gender Kidney Donation Gap’ can be understood in terms of Carol Gilligan’s claims about gender differences in ethical decision-making style, making it appropriate to analyse responses to this imbalance using an ethic of care. This article centres (...) the vast majority of living donors, those who donate in the context of a significant pre-existing relationship. A cost-neutral approach is unfair on donors who make society richer and healthier by helping a loved one. However, models of kidney sale fail to offer an acceptable alternative, either (a) compelling donors to sell into a pool where they do not know the recipient or (b) allowing affluent individuals unfair access to kidneys. Drawing on surrogacy law in England and Wales, a model of compensation is proposed that includes a range of non-financial benefits. This option celebrates donation and expresses gratitude to all donors while avoiding the pitfalls of the marketplace, with an emphasis on fair treatment of donors. Nevertheless, if more generous treatment led to a 10% increase in directed donation, then it would be equivalent to doubling ‘altruistic’ stranger donations. As long as the Gender Kidney Donation Gap persists, the best response is to minimise the discomfort and disruption caused to donors by their profound act of kindness. (shrink)

Goal: To assess public knowledge and attitudes towards the family’s role in deceased organ donation in Europe. -/- Methods: A systematic search was conducted in CINHAL, MEDLINE, PAIS Index, Scopus, PsycINFO, and Web of Science on December 15th, 2017. Eligibility criteria were socio-empirical studies conducted in Europe from 2008 to 2017 addressing either knowledge or attitudes by the public towards the consent system, including the involvement of the family in the decision-making process, for post-mortem organ retrieval. Screening and data (...) collection were performed by two or more independent reviewers for each record. -/- Results: Of the 1482 results, 467 studies were assessed in full-text form, and 33 were included in this synthesis. When the deceased has not expressed any preference, a majority of the public support the family's role as a surrogate decision-maker. When the deceased expressly consented, the respondents' answers depend on whether they see themselves as potential donors or as a deceased's next-of-kin. Answers also depend on the relationship between the deceased and the decision-maker(s) within the family, and on their ethnic or cultural background. -/- Conclusions: Public views on the authority of the family in organ donation decision-making require further research. A common conceptual framework and validated well-designed questionnaires are needed for future studies. The findings should be considered in the development of Government policy and guidance regarding the role of families in deceased organ donation. (shrink)

The cultural norms of traditional societies encourage behavior that is consistent with maximizing reproductive success but those of modern post-demographic transition societies do not. Newson et al (2005) proposed that this might be because interaction between kin is relatively less frequent in modern social networks. Assuming that people’s evaluations of reproductive decisions are influenced by a desire to increase their inclusive fitness, they will be inclined to prefer their kin to make fitness-enhancing choices. Such a preference will encourage (...) the emergence of pronatal cultural norms if social networks are dense with kin. Less pronatal norms will emerge if contact between kin makes up a small proportion of social interactions. This article reports evidence based on role-play studies that supports the assumption of the kin influence hypothesis that evaluations of reproductive decisions are influenced by a desire to increase inclusive fitness. It also presents a cultural evolutionary model demonstrating the long-term effect of declining kin interaction if people are more likely to encourage fitness-enhancing choices when interacting with their kin than with nonrelatives. D 2007 Elsevier Inc. All rights reserved. (shrink)

This article examines the impact of traditional Chinese culture on organ donation from the perspective of Confucianism, Buddhism, and Taoism. In each of these cultural systems, it appears that there are some particular sayings or remarks that are often taken in modern Chinese society to be contrary to organ donation, especially cadaveric organ donation. However, this article argues that the central concerns of Buddhism, Confucianism, and Taoism are “great love,” “ren,” and “dao,” which can be reasonably (...) interpreted to support organ donation. The author understands that each cultural system, in order to play its cultural function, must have its central concerns as well as relevant ritual practices (li) that incarnate its religious and ethical commitments. That is, each plays a general cultural role, which influences organ donation in particular not merely through abstract or general ethical principles and teachings, but through a combination of ethical teachings and the forming of particular ritual practices. This article contends that the primary reason Chinese individuals fail to donate sufficient cadaveric organs for transplantation is not because particular remarks or sayings from each of these systems appear to conflict with donation. Neither is it that the central concerns of these systems cannot support cadaveric donation. Rather, it is that modern Chinese individuals have failed to develop and secure relevant ritual practices that support the central concerns of organ transplantation. The article concludes that in order to promote more donations, there is a need to form relevant ritual practices supporting organ donation in conformity with the central concerns of these cultural systems. (shrink)

Free and informed consent is generally acknowledged as the legal andethical basis for living organ donation, but assessments of livingdonors are not always an easy matter. Sometimes it is necessary toinvolve psychosomatics or ethics consultation to evaluate a prospectivedonor to make certain that the requirements for a voluntary andautonomous decision are met. The paper focuses on the conceptualquestions underlying this evaluation process. In order to illustrate howdifferent views of autonomy influence the decision if a donor's offer isethically acceptable, three (...) cases are presented – from Germany, theUnited States, and India. Each case features a person with questionabledecision-making capacity who offered to donate a kidney for a siblingwith severe renal insufficiency. Although the normative framework issimilar in the three countries, different or sometimes even contraryarguments for and against accepting the offer were brought forward. Thesubsequent analysis offers two explanations for the differences inargumentation and outcome in spite of the shared reference to autonomyas the guiding principle: (1) Decisions on the acceptability of a livingdonor cannot simply be deducted from the principle of autonomy but needto integrate contextual information; (2) understandings of the wayautonomy should be contextualized have an important influence on theevaluation of individual cases. Conclusion: Analyzing the conceptualassumptions about autonomy and its relationship to contextual factorscan help in working towards more transparent and better justifieddecisions in the assessment of living organ donors. (shrink)

The demand for organ transplants, both globally and in South Korea, substantially exceeds the supply, a situation that might have been aggravated by the enactment of the Life-Sustaining Treatment Decision Act (LSTDA) in February 2018. This legislation may influence emergency medical procedures and the availability of organs from brain-dead donors. This study aimed to assess LSTDA’s impact, introduced in February 2018, on organ donation status in out-of-hospital cardiac arrest (OHCA) patients in a metropolitan city and identified related factors. We (...) conducted a retrospective analysis of a regional cardiac arrest registry. This study included patients aged 16 or older with cardiac arrest and a cerebral performance category (CPC) score of 5 from January 2015 to December 2022. The exclusion criteria were CPC scores of 1–4, patients under 16 years, and patients declared dead or transferred from emergency departments. Logistic regression analysis was used to analyse factors affecting organ donation. Of the 751 patients included in this study, 47 were organ donors, with a median age of 47 years. Before the LSTDA, there were 30 organ donations, which declined to 17 after its implementation. In the organ donation group, the causes of cardiac arrest included medical (34%), hanging (46.8%), and trauma (19.2%). The adjusted odds ratio for organ donation before the LSTDA implementation was 6.12 (95% CI 3.09–12.12), with non-medical aetiology as associated factors. The enactment of the LSTDA in 2018 in South Korea may be linked to reduced organ donations among patients with OHCA, underscoring the need to re-evaluate the medical and legal aspects of organ donation, especially considering end-of-life care decisions. (shrink)

This paper is an attempt to examine the traditional Yoruba beliefs about organ donation. Organ donation and transplantation remain a rare occurrence in African, this to a large extent can be as a result of the traditional African orientation on the one hand and the advancement in medical research that come with transplanting organ on the other. In this paper, we x-ray the problem of organ shortage in most African countries. We identified that apart from lack of awareness (...) on organ donation, Africans traditionally would not be willing to donate their organs after death. This paper critically examines beliefs in some African cultures and their relationship with organ donation. We analyze life after death in the Yoruba tradition and the belief in the continuation of the body after death. The paper concludes that the African belief in the continuation of the body in the afterlife contributes to the non-willingness of Africans to donate an organ after death. (shrink)

Generation Z people are a significant force driving the modern world. They lead educated lifestyles, enjoy expressing themselves creatively, and prefer to seek out new ideas or approaches to achieve the finest results. The research study aims to examine the tourism motivation and the image that affects the cultural tourism decisions of tourists of Generation Z. The study employed quantitative research techniques to gather data from 385 Thai Generation Z tourists. The research findings revealed that status and prestige (...) significantly influenced cultural tourism decisions, followed by cultural, emotional, affective, physical, and interpersonal motivation. Moreover, the pre-conceptualized image of the tourist destinations has the most significant influence on cultural tourism decisions, followed by tourists' perceptions and the tourists' feelings. This has practical implications for economic development at both the national and regional levels. At the same time, it reflects much about Generation Z's needs and expectations, calling for the urgency to preserve the cultural heritage of the locality and the country as a whole. This is expected to maintain the value of cultural tourism, generating a balance of development in the future. (shrink)

BackgroundPrevious studies have found that the decision-making process for stored unused frozen embryos involves much emotional burden influenced by socio-cultural factors. This study aims to ascertain how Japanese patients make a decision on the fate of their frozen embryos: whether to continue storage discard or donate to research.MethodsTen Japanese women who continued storage, 5 who discarded and 16 who donated to research were recruited from our infertility clinic. Tape-recorded interviews were transcribed and analyzed for emergent themes.ResultsA model of patients’ (...) decision-making processes for the fate of frozen embryos was developed, with a common emergent theme, “coming to terms with infertility” resulting in either acceptance or postponing acceptance of their infertility. The model consisted of 5 steps: 1) the embryo-transfer moratorium was sustained, 2) the “Mottainai”- embryo and having another child were considered; 3) cost reasonability was taken into account; 4) partner’s opinion was confirmed to finally decide whether to continue or discontinue storage. Those discontinuing, then contemplated 5): the effect of donation. Great emotional conflict was expressed in the theme, steps 2, 4, and 5.ConclusionsPatients’ 5 step decision-making process for the fate of frozen embryos was profoundly affected by various Japanese cultural values and moral standards. At the end of their decision, patients used culturally inherent values and standards to come to terms with their infertility. While there is much philosophical discussion on the moral status of the embryo worldwide, this study, with actual views of patients who own them, will make a significant contribution to empirical ethics from the practical viewpoint. (shrink)

This study focused on the influence of American and Chinese cultures on consequentialism orientation in decision-making within the broader context of psychologists’ academic roles and responsibilities. In addition, this study hypothesized that educational level would affect culturally influenced ethical decision making in both cultures. Based on the American Psychological Association Ethics Code, 20 ethical scenarios in 5 domains in psychology were created and used to examine the influence of culturally ethical beliefs on psychologists’ decision making among 181 participants. The results (...) indicated that significant cultural differences in consequentialism orientation differentiated Chinese and American participants and influenced their resolution of ethical issues. (shrink)

The phrase ‘chết phải toàn thây’, which has no direct English translation, can be roughly interpreted as ‘one must die with an intact body’. This belief, deeply rooted in Vietnamese culture, significantly influences how the body is treated after death. It is often linked to the idea that the body must remain whole for the soul to rest peacefully or transition smoothly into the afterlife. While many societies, particularly in the Western world, view the donation of organs after (...) death as a noble act, the belief in ‘chết phải toàn thây’ poses a significant barrier to promoting organ donation in Vietnam. This essay highlights the cultural origins of this belief and explores a broader interpretation of ‘toàn thây’ or ‘intact body’ in the modern era. The phrase ‘chết phải toàn thây’, firmly ingrained in Vietnamese culture for thousands of years, reflects the influence of religious and philosophical traditions, particularly Confucianism, Buddhism and Taoism.1 Confucianism emphasises filial piety (xiao), which includes preserving bodily integrity after death as a sign of respect for one’s parents and ancestors.2 Taoism, with its focus on the soul’s immortality and harmony with nature, regards the body as a sacred vessel crucial for maintaining a balance between the physical and spiritual realms.2 Together, these traditions form a cultural framework that assigns profound spiritual and emotional significance to the body, making its preservation a deeply held …. (shrink)

Sociocultural norms against women can contribute to promoting intimate partner violence (IPV) and shape women's decision to disclose IPV. A cross‐cultural analysis of the existing literature is needed to present an overview of the influences of sociocultural norms on women's decisions regarding the disclosure of IPV across different cultural contexts. The purpose of the review was to synthesize published quantitative, qualitative, and mixed methods (MMs) studies to identify known sociocultural norms across different cultures that may influence (...) women's decision to disclose IPV. The Whittemore and Knafl framework, Rayyan software, and PRISMA flow diagram were used. Databases included APA PsycInfo, CINAHL, PubMed, SocINDEX, and Women's Studies International. The quality of studies was assessed by the MMs appraisal tool. A total of 15 research articles written in English and published in peer‐reviewed journals were included. Main categories emerged: (1) stigma surrounding IPV disclosure, victimization, and divorce; (2) gender roles; (3) preserving family honor; and (4) Children's well‐being and future. A one‐size‐fits‐all approach is not adequate for women who are considering disclosing IPV. Findings underscore that regardless of residing in individualistic countries, those sociocultural norms related to traditional gender roles and gender inequality are still important barriers to the disclosure of IPV among women with collectivist roots. (shrink)

Background The ethical principle of justice demands that resources be distributed equally and based on evidence. Guidelines regarding forgoing of CPR are unavailable and there is large variance in the reported rates of attempted CPR in in-hospital cardiac arrest. The main objective of this work was to study whether local culture and physician preferences may affect spur-of-the-moment decisions in unexpected in-hospital cardiac arrest. Methods Cross sectional questionnaire survey conducted among a convenience sample of physicians that likely comprise code team (...) members in their country. The questionnaire included details regarding respondent demographics and training, personal value judgments and preferences as well as professional experience regarding CPR and forgoing of resuscitation. Results Of the 675 questionnaires distributed, 617 were completed and returned. Country of practice and level of knowledge about resuscitation were strongly associated with avoiding CPR performance. Mexican physicians were almost twicemore likely to forgo CPR than their Israeli and Indonesian/Malaysian counterparts [OR1.84, p = 0.038]. Mexican responders also placed greater emphasison personal and patient quality of life. In multivariate analysis, degree of religiosity was most strongly associated with willingness to forgo CPR; orthodox respondents were more than twice more likely to report having forgone CPR for apatient they do not know than secular and observant respondents, regardless of the country of practice [OR 2.12, p = 0.003]. Conclusions In unexpected in-hospital cardiac arrest the decision to perform or withhold CPR may be affected by physician knowledge and local culture as well as personal preferences. Physician CPR training should include information regarding predictors of patient outcome at as well as emphasis on differentiating between patient and personal preferences in an emergency. (shrink)

The contention that organizational culture influences ethical decision making is not disputable. However, the extent to which it influences ethical decision making in the workplace is a topic for scholarly debate and investigation. There are scholars who argue that, though corporate values are a powerful force in explaining the behavior of individuals and groups within organizations, these values are unperceived, unspoken, and taken for granted. However, there are others who argue that the formalization of corporate values facilitates job (...) and role clarity and is the key to influencing employee behavior. The purpose of this study is to examine the extent of the influence of organizational codes of ethics. The findings suggest that, depending upon the particular situation, corporate culture and ethics may mitigate individual personal moral convictions about right and wrong. (shrink)

We investigate the cross-cultural relationships between spirituality and ethical decision-making in Norway and the U.S. Data were collected from business students ( n = 149) at state universities in Norway and the U.S. Results indicate that intention to behave ethically was significantly related to spirituality, national culture, and the influence of peers. Americans were significantly less ethical than Norwegians based on the three dimensions of ethics, yet more spiritual overall. Interestingly, the more spiritual were Norwegians, the more ethical was (...) their decision-making. By contrast, the more spiritual were Americans, the less ethical was their decision-making. The research also found that peer influences were more important to Norwegians than to Americans in making ethical decisions. Finally, spiritual people from the U.S. were more likely to use a universalistic form of justice ethics, as opposed to a more particularistic form of justice ethics used by Norwegians. (shrink)

In the contemporary digital age, recommender systems (RSs) play a fundamental role in managing information on online platforms: from social media to e-commerce, from travels to cultural consumptions, automated recommendations influence the everyday choices of users at an unprecedented scale. RSs are trained on users’ data to make targeted suggestions to individuals according to their expected preference, but their ultimate impact concerns all the multiple stakeholders involved in the recommendation process. Therefore, whilst RSs are useful to reduce information overload, (...) their deployment comes with significant ethical challenges, which are still largely unaddressed because of proprietary constraints and regulatory gaps that limit the effects of standard approaches to explainability and transparency. In this context, I address the ethical and social implications of automated recommendations by proposing a pro-ethical design framework aimed at reorienting the influence of RSs towards societal interest. In particular, after highlighting the problem of explanation for RSs, I discuss the application of beneficent informational nudging to the case of conversational recommender systems (CRSs), which rely on user-system dialogic interactions. Subsequently, through a comparison with standard recommendations, I outline the incentives for platforms and providers in adopting this approach and its benefits for both individual users and society. (shrink)

Given the recent ethics scandals in the United States, there has been a renewed focus on understanding the antecedents to ethical decision-making in the research literature. Since ethical norms and standards of behavior are not universally consistent, an individual’s choice of referent may exert a large influence on his/her ethical decision-making. This study used a social identity theory lens to empirically examine the relative influence of the macro- and micro-level variables of national culture and peers on an individual’s intention to (...) behave ethically. Our sample consisted of respondents from Germany, Italy, and Japan. The results indicated that both national culture and peers were found to act as significant referents in ethical decision-making dilemmas. Although peers exerted a much stronger influence on an individual’s ethical decision-making, the impact of peers varied depending on the national culture levels of individualism and power distance. (shrink)

Entrepreneurial perspectives are distinct approaches individuals use to identify opportunities and navigate challenges in the business world, shaping their risk evaluation, innovation, and strategic decision-making for growth and success. This study aims to evaluate how entrepreneurial perspectives shape and influence organizational culture. By examining the interplay between entrepreneurial attitudes and organizational standards, it seeks to understand their impact on organizational dynamics and effectiveness. This study explores entrepreneurial perspectives and organizational culture through the analysis of 500 applications using structured questionnaires. The (...) study used statistical methods like descriptive statistics, confirmatory factor analysis, correlation analysis, hypothesis testing, and chi-square tests to analyze the impact of proactiveness, self-efficacy, and employee engagement on organizational culture. The statistical analysis conducted using SPSS software reveals that proactiveness (CR = 0.911, R² = 0.789) and self-efficacy (CR = 0.864, R²= 0.876) significantly enhance organizational culture. Employee engagement also shows a significant impact (CR = 0.879, R² = 0.859). In contrast, collaboration (CR = 0.906, R² = 0.892) and visionary thinking (CR = 0.945, R²=0.555) do not significantly influence or mediate relationships with organizational culture, as indicated by non-significant p-values. Entrepreneurial perspectives significantly shape organizational culture by introducing innovative ideas and risk behaviors, enhancing competitiveness and responsiveness in a rapidly changing market. (shrink)

The demand for principled and transparent corporate moral judgement and ethical decision making in the workplace makes it necessary for business students as future managers to understand the expectations of ethical workplace conduct. Corporate scandals mean that there is enhanced interest in ensuring that ethical content is included in curricula in universities. In this study, we re‐visit the question of whether culture has an influence on ethical perceptions of workplace scenarios, using students enrolled in a College of Business in a (...) New Zealand (NZ) university as respondents. Consistent with current research, this study demonstrated mixed results. However, we also found evidence to suggest some identifiable patterns in the data across cultural groups. Overall, Chinese and Other respondents were more likely than NZ European to consider the scenarios as ethical. On the other hand, Chinese respondents were significantly less likely to report that their peers would carry out ethically questionable actions. (shrink)

Using samples from the U.S. and Puerto Rico, we examine cross-cultural differences in cultural value dimensions, and relate these to act and rule utilitarian orientations, and ethical decision making of business professionals. Although these places share the same legal environment, culturally they are distinct. In addition to tests of between-group differences, a model in which utilitarian orientation mediates the influence of cultural values on ethical decisions was evaluated at the individual level of analysis. Results indicated national (...) culture differences on three cultural values, but no between-group differences on utilitarian orientations and ethical decisions. Significant indirect effects were found; act utilitarian orientation mediated the effects of two values activity orientation and universalism on ethical decision making. Implications for international management practices and business ethics are discussed. (shrink)

Kidney donation by young children and the mentally retarded has been supported by court decisions, arguments based on obligations inherent in family relationships, an array of contextual factors, and the principle of beneficence. These justifications for taking organs from people who cannot protect themselves are problematic and must be weighed against our obligation to protect the vulnerable. A compromise solution is presented that strongly protects young children and the mentally retarded but does not abdicate all responsibility to (...) relieve suffering. Guidelines are proposed that prohibit the retrieval of kidneys from young children and the mentally retarded but permit one exception. They would allow retrieval of a kidney when the consequence to a first order relative with whom the donor has a meaningful and valuable relationship is otherwise imminent death. This would be done in accordance with additional guidelines that minimize harm to the donor. Since most patients with end stage renal disease can be maintained on dialysis the need for a kidney to prevent death should be an uncommon occurrence. This compromise is proposed as a solution to a dilemma that exists because two ethical principles are in conflict and one cannot be honored without violating the other. (shrink)

In this chapter, we provide an overview of the ethical considerations relevant to the use of nudges in organ donation policy. We do not defend a position on the permissibility of nudging in this context, but instead aim to clearly outline the strongest arguments on the different sides of this issue that have been presented in the English-language scholarly bioethics literature. We also highlight the questions that are in need of further investigation. In part 1, we briefly discuss nudging (...) before considering proposals to use nudges to increase the number of registered organ donors, including opt-out donor registration systems and the use of “nudge statements.” In part 2, we discuss the use of nudges to influence the decision-making of family members in circumstances where they have a veto over the donation of their loved one’s organs. (shrink)

OBJECTIVE: How outside factors affect physician decision making remains an open question of vital importance. We sought to investigate the importance of various influences on physician decision making when clinical guidelines differ from patient preference. -/- METHODS: An online survey asking 469 primary care providers (PCPs) across four practice sites whether they would order magnetic resonance imaging for a patient with uncomplicated back pain. Participants were randomized to one of four scenarios: a patient's preference for imaging (control), a patient's (...) preference plus a colleague's opinion against imaging (colleague), a patient's preference plus a professional society's recommendation against imaging (profession), or a patient's preference plus an accountable care organization's quality metric that measures physician use of imaging (ACO). Demographic information and the reasoning behind participants' decisions also were obtained. -/- RESULTS: A total of 168 PCPs completed the survey, yielding a 36% completion rate. A majority chose not to pursue imaging: control 68%, colleague 85%, profession 87%, and ACO 78%. Multivariate logistic regression revealed that participants were more likely not to order advanced imaging only when reminded of a professional society recommendation (P = 0.017). Regression also suggested that practice site exerted an effect on the primary outcome. Evidence-based medicine and clinical judgment were the most cited reasons for the decision. -/- CONCLUSIONS: Our results reinforce the potential to leverage professional societies to advance evidence-based medicine and reduce unnecessary testing. At the same time, practice site appeared to exert influence, suggesting that these recommendations must be part of local institutional culture to be effective. (shrink)

This paper addresses a significant gap in the conceptualization of business ethics within different cultural influences. Though theoretical models of business ethics have recognized the importance of culture in ethical decision-making, few have examinedhow this influences ethical decision-making. Therefore, this paper develops propositions concerning the influence of various cultural dimensions on ethical decision-making using Hofstede''s typology.

This article makes an empirically based contribution to the general debate on the mediatization of politics by looking at the Finnish policy networks as a particular context in which the general processes of mediatization are recognized and where the influences of mediatization are negotiated. Drawing on a qualitative interview sample of 60 elite decision-makers and an elite survey, three themes related to mediatization are highlighted: the role of trust in policy networks, the dynamics of the mutual professionalization of media (...) and politics, and the differentiation of network rationality and media rationality. These findings are at the same time evidence of a general process of mediatization and of how local conditions shape that process. (shrink)

Background The principle of respect for autonomy (PRA) is a central tenet of bioethics. In the quest for a global bioethics, it is pertinent to ask whether this principle can be applied as it is to cultures and societies that are devoid of the Western sociopolitical historical pressures that led to its emergence. Relational autonomists have argued for a more inclusive approach to patient autonomy which takes into account factors such as interdependency and social relations. However, at the outset of (...) any relational approach, it is necessary to identify underlying factors that influence patient autonomy in non-Western cultures. Objective To conduct a review of the literature to uncover the mechanisms through which social, cultural, and religious factors influence and impact the application of the PRA in healthcare decision-making in non-Western cultures and societies. Methods We conducted a systematic review through a comprehensive search of three major electronic databases of biomedical sciences. Returned citations were imported to Covidence, full texts were assessed for eligibility, included articles were thoroughly reviewed and data was synthesized. PRISMA guidelines were followed. Results Our search retrieved 590 non-duplicate results, 50 of which were included after screening and full-text eligibility checks. The included studies were predominantly qualitative in nature, with few quantitative, mixed-methods, and review studies included. Our synthesis of data identified nine key factors that influenced patients’ autonomous decision-making through cultural, social, religious, or intersectional pathways. Conclusion Two main conclusions emerge from this review. Firstly, there is a notable dearth of bioethical research examining the influence of diverse factors on patients’ inclination towards different conceptions of autonomy. Secondly, the analysis of prevalent collectivist cultures and deference of autonomy adds value to the solution-oriented relational autonomy debate. This raises questions regarding how decision-making can be truly autonomous in the presence of such large-scale factors, warranting further attention. (shrink)

Culture creates the context within which individuals experience life and comprehend moral meaning of illness, suffering and death. The ways the patient, family and the physician communicate and make decisions in the end-of-life care are profoundly influenced by culture. What is considered as right or wrong in the healthcare setting may depend on the socio-cultural context. The present article is intended to delve into the cross-cultural perspectives in ethical decision making in the end-of-life scenario. We attempt to (...) address the dynamics of the roles of patient, family and physician therein across two countries from East and West, namely, India and Germany. In India, where illness is more a shared family affair than an individual incident, a physician is likely to respect the family’s wishes and may withhold the ‹naked truth’ about the diagnosis of a fatal disease to the patient. In Germany, a physician is legally required to inform the patient about the disease. In India, advance directive being virtually non-existent, the family acts as the locus of the decision-making process, taking into account the economic cost of available medical care. In Germany, advance directive is regarded as mandatory and healthcare is covered by insurance. Family and the physician appear to play larger roles in ethical decision making for patients in India than for those in Germany, who place greater emphasis on autonomy of the individual patient. Our study explicates how culture matters in ethical decision-making and why the bioethical discourse is necessary in the concrete realities of the socio-cultural context. To explore the possibility of finding a common ground of morality across different cultures while acknowledging and respecting cultural diversity, thus remains a formidable challenge for the bioethicists. (shrink)

Financial and cost accounting information is processed by decision-makers guided by their particular need to support decisions. Recent technological advances impacting on information as well as organizations such as the European Community mandating financial reporting requirements for many countries is rapidly changing the landscape for decision making using accounting information. Hence, the importance of individuals'' decision making is more important than it was previously. These decisions are also influenced by individuals'' ethical beliefs. The Throughput Modeling approach to (...) class='Hi'>cultural and ethical concerns provides a way of dealing with accounting information processed through various pathways by decision-makers. This modeling approach captures different philosophical perspectives from which to understand what is involved in "thinking scientifically." In the Throughput Modeling approach, pathways highlight the importance of how different philosophical perspectives may be used by individuals in arriving at a decision. This paper highlights key concepts involved in rethinking the basis of moral decision making in terms of an underlying process, rather than focusing on the application of principles or the development of a virtuous character. Examples are provided from both English and Spanish settings to help emphasize the importance of modeling ethical decision making globally. (shrink)

Chronic shortage in organs for transplantation worldwide is leading many policy-makers to consider various incentives that may increase donation rates.1 These range from giving holders of donor cards some priority on the transplant waiting list or a discount on health insurance premiums, to giving families who consent to donation a medal of honour, reimbursement of funeral expenses, tax incentives or even financial compensation.2–4 Of the various proposed incentive mechanisms, the one that has consistently garnered the most criticism and (...) objection in the literature is that of paying families who consent to donate the organs of a deceased loved one.Arguments against such a policy abound: it could exploit the poor, influence the family to prematurely withdraw care, encourage families to withhold medical information that would result in transplant-transmission of disease, and finally, it would commercialise the value of human life and result in the perception of human organs as commodities. Indeed, to date no Western country has adopted a policy of financial compensation to families for consenting to organ donation.2Recently, a country suffering from severe shortage in organs has implemented a policy of financial incentives that uses cash payments. Wu and Fang5 describe a recent pilot programme in China that compensates families for postmortem donation, through an independent third party and based on consent or presumed consent of the deceased. The particular context within which this programme is implemented validates and even exacerbates some ethical concerns that have been voiced in the Western medical and bioethics …. (shrink)

This article addresses the problematic perspectives of drone culture. In critiquing focus on the drone’s apparent ‘autonomy’, it argues that such devices function as part of a socio-technical network. They are relational parts of human–machine interaction that, in our changing geopolitical realities, have a powerful influence on politics, reputation and warfare. Drawing on Žižek’s conception of parallax, the article stresses the importance of culture and perception in forming the role of the drone in widening power asymmetries. It examines how perceptions (...) of autonomy are evoked by drones, to claim that this misperception is a smokescreen that obscures the relational socio-technical realities of the drone. The article therefore argues that a more critical culture of the drone emerges by shifting the focus and perception from autonomy to anonymity. This allows us to engage more fully with the distributed agency and decision-making that define how drones are developed and deployed. Rather than focusing on the drone as a singular, fetishised, technical object, a relational approach to the drone assemblage is proposed that highlights the competing human interests that define and resist drones in global politics and culture. (shrink)

Employee behavior, decision-making, and cooperation across the supply chain network are all greatly influenced by organizational culture (OC). In supply chain outcomes (SCO), an understanding of the effect promotes efficiency overall, improves coordination, and maximizes performance. The structural equation modeling (SEM) technique was initially applied to experimentally analyze data from a survey of 85 enterprises using a quantitative approach. The relationships between cultures such as OC, market culture (MC), clan culture (CC), Hierarchy culture (HC), Professional culture (PC), Adhocracy culture (AC), (...) and supply chain outcomes are analyzed in this research. The findings are evaluated using the combination of a reliability and validity test, multiple regression analysis. The SEM approach is employed to investigate the intricate correlation that exists between these cultural aspects and SCO. A more detailed comprehension of these linkages is provided by the simulation technique, which enables a thorough investigation of the ways in which each cultural feature affects SCO. Positive correlations between the independent variables (OC, AC, MC, HC, PC, and CC) and the dependent variable (SCO) are predicted. The majority of these relationships exhibit statistically significant positive impacts(p < 0.05), signifying noteworthy and substantial benefits for SCO. Furthermore, although OC, AC, MC, PC, and CC have substantial positive impacts, HC has a relevant but invisible effect. OC has a major influence on SCO, according to the study, with some cultural characteristics having a considerable impact on performance measures. Improved efficacy and efficiency in supply chain operations are fostered by a well-aligned culture. (shrink)

We conducted an intertemporal online experiment to examine the contagion of others’ positive and negative donation behaviors. We collected two sets of data during and after the peak of the COVID-19 pandemic in China. The participants donated to the charitable fund, “Against COVID-19, The China Charity Federation Is on the Move.” We further investigated the mediating effect of social anxiety on the link between the contagion of donation behaviors and the changes in the COVID-19 situation. A total of (...) 1022 participants participated in the intertemporal online experiment and were considered in the statistical analyses. Our findings were as follows. First, the donation behaviors of others significantly changed these participants’ initial donation decisions, with increased or decreased donation amounts being associated with a positive or negative donation behavior, respectively. Others’ positive donation behavior was more likely to nudge these participants into changing their initial decisions than negative donation behavior during the peak of the pandemic. However, such difference disappeared after the peak because the contagion of positive donation behavior significantly decreased along with the abatement of the pandemic. Second, the participants’ social anxiety decreased along with the abatement of the pandemic, and social anxiety completely mediated the relationship between the pandemic abatement and the decrease in the contagion of positive donation behaviors. These findings advance our understanding of the motivations and influence mechanism of individuals’ donation decisions in the current pandemic situation and help make informed policy making decisions. (shrink)

Humility is increasingly recognized as an essential attribute for individuals at top management levels to build successful organizations. However, research on CEO humility has focused on how humble chief executive officers (CEOs) shape collective perceptions through their interactions and behaviors with other organizational members while overlooking CEOs’ critical role in making strategic decisions. We address this unexplored aspect of CEO humility by proposing that humble CEOs influence decision-making decentralization at the top management team (TMT) and subsequently promote an organizational (...) ethical culture. Using a sample of CEOs and TMT members from 120 small- and medium-sized enterprises, we find strong support for our hypotheses. We discuss important implications for research on CEO humility and strategic leadership. (shrink)

Prior work shows that capital market participants including investors, analysts, and managers are all impacted by the prevailing level of investor sentiment. We extend this line of work by investigating whether the effects of sentiment spill over into the nonprofit sector by affecting donors’ spending to support moral causes. While donors are driven by ethical, altruistic, and other utility-maximizing motives, it is unclear whether behavioral biases stemming from sentiment would influence donors’ decisions to give. We shed light on this (...) issue using a large industry-diverse panel of over 115 thousand organization-years from 2008 to 2016. Results indicate that nonprofit organizations receive less in stock-based donations and more in cash-based donations during periods of high investor sentiment. Our inquiry separately considers cash and stock-based donations because we expect, and find, that market-related sentiment impacts these types of contributions differently. Moreover, we find that these effects are stronger for organizations with large donors, who are more closely tied to the capital markets, and therefore more susceptible to investor sentiment, as well as charitable organizations, consistent with “tug-at-the-heartstrings” type appeals inducing more emotional donation response. Taken together, the results suggest that market-wide investor sentiment impacts nonprofit organizations and the effects vary in the cross-section. (shrink)

In recent years, Chinese Generation Z has shown a strong enthusiasm for the Myers-Briggs Type Indicator (MBTI), often attributing academic or life challenges to their MBTI personality types. This study aims to explore the effects of MBTI on academic major selection, academic performance, and career decision-making among first-year university students in China. Data were collected from 203 freshmen across seven majors at a comprehensive university in Guangdong Province using MBTI personality test scales, peer evaluations, and an open-ended career decision questionnaire. (...) Statistical and correlation analyses were conducted using SPSS 27. The findings revealed that: (1) the Judging/Perceiving dimension is significantly correlated with structured disciplines; (2) Intuitive students tend to perform better academically; and (3) MBTI has a limited impact on career decision-making. These results suggest that while MBTI can offer insights into student preferences, its predictive power is constrained, especially in culturally and societally influenced contexts. Educators should take these factors into account when utilizing MBTI in academic settings and encourage students to explore career paths beyond their perceived personality constraints. (shrink)

This paper tests the claims of cultural theory using the formation of climate change policies in Sweden, the United States, and Japan as case studies. The theory posits that any social group consists of three main cultural types: the egalitarian, the market -oriented, and the hierarchical. Though all groups contain elements of each type, one cultural type usually prevails, giving the group its unique decision-making character. This paper applies cultural theory at the national level, testing to (...) what extent the theory is able to project how countries will respond in addressing the issue of global warming. The results suggest that cultural theory may be useful to those involved in developing international agreements, enabling them to formulate regimes which are compatible with various cultural styles. (shrink)

Norway provides total social welfare coverage for organ transplantations, including free immunosuppressive medication and prepaid life-long follow up for both recipients and donors. Despite these benefits the proportion of living kidney donors has in recent years declined from around 40% of all kidney transplantations to 24%. This study suggests harnessing patient- and donor-narratives as a tool for addressing the current fall in donation rates. The hospital records of 18 recipient/donor dyads were compared with patient and donor accounts (...) elicited in semi-structured interviews. Narratives afford a pertinent supplement to the primarily biomedical and technical information stored in medical records. Even in condensed form, the messages embedded in narratives contribute to a ‘thicker’ understanding of the complexity of living kidney donation -decisions. Narratives represent a source of education for referring-nephrologists wishing to deepen their evaluation skills and avoid making decisions based on insufficient insight into patients’ and potential donors’ values and life-situation. Recipients’ and donors’ unedited accounts of their motivations, worries, doubts and expectations afford a revealing and edifying supplement to the primarily biomedical and technical information stored in medical records. In narratives, the predicaments and dilemmas surrounding LKD become visible and debatable and can serve as support for future donors, recipients and the nephrologists responsible for evaluation–conclusions. Generating narratives raises a number of practical, epistemic and normative challenges. (shrink)

Preference formation and choice are dynamic cognitive processes arising from interactions between decision-makers and their immediate choice environment. This thesis examines how preferences and decisions are played out in visual attention, captured by eye-movements, as well as in group contexts. Papers I-II make use of the Choice Blindness paradigm. Paper I compares participants’ eye movements and pupil dilation over the course of a trial when participants detect and fail to detect the false feedback concerning their choices. Results indicate objective (...) markers of detection with important implications for questions concerning possible demand effect or cognitive dissonance explanations of choice blindness. Paper II examines another aspect of the choice environment, namely, the social context. Choice blindness is demonstrated in small groups for the first time. It is shown that preferential change can be induced in dyads by manipulating the group’s beliefs about their choices, thus extending the preference change through choice effects beyond individuals for the first time. Paper III examines how visual attention differentially supports both decision and memory processes depending on the amount of task-relevant information available to participants. Participants’ performance and visual attention dynamics was found to vary depending on the amount of information available to them, and the results indicate that decision outcomes are heavily influenced by encoding prior to traditional choice phases used in decision research. Papers IV-VII concern decision-making in the moral domain. Paper IV investigates visual attention when participants choose between difficult moral dilemmas, showing asymmetries in how participants distribute their attention depending on making utilitarian or deontological choices. Paper V introduces a novel paradigm for influencing decision based manipulating the timing of decision by measuring the direction of gaze while the participant deliberates. Using this method participants’ moral decisions were biased without their knowledge to a randomly chosen alternative. This shows that moral decision and visual attention are highly coupled and that by simply knowing where someone is looking it is possible to influence their decision process. Papers VI&VII build on the links between gaze direction and moral choice and present the first computational decision models based on eye gaze applicable to the moral domain. Paper VI for choices between abstract principles and Paper VII for donations to charitable organizations. Together the papers advance novel methodological solutions to understanding preferences and decisions across a number of domains, both highlighting the important contributions of social and sensorimotor interactions to the content of our decisions as they develop over time, as well as demonstrating how decisions can be influenced by leveraging those interactions. (shrink)